Diversify Your Clinical Trials With ASCO-ACCC Resources

J Clin Pathways. 2022;8(5):18.

In July, the American Society of Clinical Oncology (ASCO) and the Association of Community Cancer Centers (ACCC) jointly released resources to help research sites increase racial and ethnic equity, diversity, and inclusion in cancer clinical trials. The Just ASK Training Program and Site Self-Assessment are available free of charge and represent a full and complementary set of resources that can help research sites address barriers to participation in cancer clinical trials among racial and ethnic populations that have been historically underrepresented.

• The ASCO-ACCC Equity, Diversity, and Inclusion Research Site Self-Assessment helps research sites identify systemic areas that are known to affect the diversity of clinical trials and provides site-specific recommendations to modify rules and procedures.
• The Just ASK Training Program identifies opportunities for change at the individual level and provides real-world examples to enhance understanding of participants.
• The Just ASK Training Facilitation Guide provides guidance to continue the conversation around implicit biases after the initial training.

This 60-minute course features didactic slides, interactive case studies, and interview segments to demonstrate how implicit biases interplay with health disparities and how to explore strategies for addressing barriers to trial participation among underrepresented populations. The training program commences with a review of the key concepts using visuals and examples to illustrate definitions. For instance, in discussing equality vs equity, the segment depicts a group of individuals with differing heights, including a person who uses a wheelchair, who are trying to reach for apples on a tree. Equality, in this context, would mean giving everyone the same stepping stool to help them reach higher; equity would be giving each individual the customized boost each needs to ensure that all hands reach the same height on the tree. Visual learners will appreciate the use of illustrations to portray these key concepts.

After the conceptual review, the training program incorporates an activity in which the learner designates different real-world scenarios as examples of equity or equality (ie, hosting a health seminar in English and inviting everyone to attend, or hiring translators to attend a community meeting about health concerns). Learners click on buttons to uncover common implicit biases in health care (ie, women presenting with cardiac disease symptoms are less likely than men to receive diagnosis, referral, and treatment due to misdiagnosis of stress and/or anxiety). There are also a series of real-world case studies that present patients with cancer of various health and socioeconomic backgrounds who are being evaluated for clinical trials. For each patient, the training program asks learners to identify what they perceive as potential barriers to trial participation (ie, history of substance abuse, long commute, hesitant to enroll, etc); in response, the training program suggests additional questions to ask the patient to gauge their barrier (ie, concerns about long-term effects of substance abuse are valid—does the patient have ongoing support for this? Long commute may seem like the primary barrier for this patient—but does the patient think so? What’s behind her reluctance to participate?). Health care providers should find it impactful not only to consider these cases and acknowledge their own implicit biases, but most importantly, to work through their biases and perceived barriers by getting to know how the patient feels and what their concerns are.

Overall, this training program encourages research teams to critically assess their practices and brainstorm improvements or additions that they can make to address systemic barriers and advance health equity.

Access the Equity, Diversity, and Inclusion Research Site Self-Assessment.

Access the Just ASK Training Program.

Download the Just ASK Training Facilitation Guide.